11070124 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10406 TONITA WAY CONTRACTOR:CALIFORNIA HOME PERMIT NO:11070124
BUILDERS&DESIGN r
OWNER'S NAME: SIVAKUMAR DANDAPANI&MAHADEVAN UMA 1775 JUNCTION AVE DATE ISSUED: 12/12/2011
OWNER'S PHONE: 4083403826 SAN JOSE,CA 95112 PHONE NO:(408)392-8200
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❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG'
ELECT PLUMB
License Class_ Lic.# RA?i � "
s, MECH RESIDENTIAL COMMERCIAL
Contractor � (�� I ("p�'�Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-BUILD-ADD 2ND FLOOR 1,433 SQ FT M.SUITE,2
(commencing with Section 7000)of Division 3 of the Business&Professions BEDROOMS,LOUNGE&BALCONY W/BATHROOM-REMODEL
Code and that my license is in full force and effect. EXISTING 2,054 SQ FT FLOOR PLAN FAMILY,KITCHEN,
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$500000
permit is issued.
APPLICANT CERTIFICATION APN Number:35915043.00 Occupancy Type:
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against sa - in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,t e.apunderstands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulata ca—pe e Cupertiro Municipal Code,Section
9.18.
sur
Issued bye x - Date: ,,-`r'.-l 2,": 7
Signature - Date_
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Oner or authorized/ a t:
forthwith comply with such provisions or this permit shall be deemed revoked. '�'�`'^�" 4 °z® / �Dat;
APPLICANT CERTIFICATION CONSTRUCT16N�L>`NDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of vmrk's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
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Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10406 tonita way DATE: 07/19/2011 REVIEWED BY: bobs.
APN: BP#: 110-701 "VALUATION: 1$500,000
.PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex 2nd Unit? 0 Yes 0 No PENTAMATION 1 R3SFDW
USE: PERMIT TYPE:
WORK sfd re-build add master suite 2 bedrooms lounge, balcony bath 1st floor add family, kitchen dining,
SCOPE patio, living, 3 bedrooms, 2 baths, sitting area.
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 3,310 $2,871.11 IR3PLNCK $2,919.78 IR3INSP
TOTALS: 3,310 $2,871.11 $2,919.78
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NOTE: These,fees are based on the prellininary information available and are only an estimate. Contact the De t or adds 11 info.
FEE ITEMS (Fee Resohition 11-053 Is;'. 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,871.11 Select a Misc Bldg/Structure
Suppl.PC Fee: G Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $2,919.78
Suppl.Insp.Fee:G Reg. 0 OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Constr. Tax: IBCONSTAXR #new $579.61
units
Acoustical Fee: 0 Yes 0 No $0.00 0
Work Without Permit? 0 Yes 0 No $0.00
Planning Fee: PLLONGRNGR $430.30 Select a Non-Residential Q
Building or Structure 0
A
Strong.Motion Fee: IBSEISMICR $50.00 Select an Administrative Item
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Bldg Stds Commission Fee: IBCBSC $20.00
SUBTOTALS: $6,870.80 $0.00 TOTAL FEET 1 $6,870.80
Revised: 07/04/2011